Community Home Repair Program

Please complete and submit this application to determine if you qualify for Habitat for Humanity of Lincoln County's Community Home Repair program. Please fill out the application as completely and accurately as possible. All information you include on this application will be kept confidential.

Equal Housing Opportunity: “We are pledged to the letter and spirit of US policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, or national origin.”

Applicant Information

First Name *

Last Name *

Email *

Gender

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Applicant information

Do you speak and read English?

Are you over 55 years of age?

Are you a veteran?

How long have you owned your home? The maximum length for the field How long have you owned your home? is 500 characters.

Do you have special needs or disabilities we should be aware of? The maximum length for the field Do you have special needs or disabilities we should be aware of? is 500 characters.

Co-Applicant Information

Co-Applicant Name The maximum length for the field Co-Applicant Name is 500 characters.

Do you speak and read English?

Are you over 55 years of age?

Are you a veteran?

Do you have special needs or disabilities we should be aware of? The maximum length for the field Do you have special needs or disabilities we should be aware of? is 500 characters.

Co-Applicant email The maximum length for the field Co-Applicant email is 500 characters.

Co-Applicant phone The maximum length for the field Co-Applicant phone is 500 characters.

Other Household Members

Please list all household members that reside at this home

Name The maximum length for the field Name is 500 characters.

Relationship The maximum length for the field Relationship is 500 characters.

Employed

Student

Age The maximum length for the field Age is 500 characters.

Gender The maximum length for the field Gender is 500 characters.

Name The maximum length for the field Name is 500 characters.

Relationship The maximum length for the field Relationship is 500 characters.

Employed

Student

Age The maximum length for the field Age is 500 characters.

Gender The maximum length for the field Gender is 500 characters.

Name The maximum length for the field Name is 500 characters.

Relationship The maximum length for the field Relationship is 500 characters.

Employed

Student

Age The maximum length for the field Age is 500 characters.

Gender The maximum length for the field Gender is 500 characters.

Present Housing Conditions

Type of Home * The field Type of Home is required.

What year was your home built? Note: Manufactured homes build before 1978 are not eligible . * The field What year was your home built? Note: Manufactured homes build before 1978 are not eligible . is required.

Is this home your primary residence? * The field Is this home your primary residence? is required.

How long have you lived in the home? * The field How long have you lived in the home? is required.

Is there a mortgage on the home? * The field Is there a mortgage on the home? is required.

If there is a mortgage, are you current with your payments? Note: If no, you are not eligible for the program. * The field If there is a mortgage, are you current with your payments? Note: If no, you are not eligible for the program. is required.

Is your home insured? Note: If no, you are not eligible for the program. * The field Is your home insured? Note: If no, you are not eligible for the program. is required.

Do you own property other than your primary residence?

If yes, please describe. The maximum length for the field If yes, please describe. is 500 characters.

Employment Information

Applicant - Employment The maximum length for the field Applicant - Employment is 500 characters.

Co-applicant employment The maximum length for the field Co-applicant employment is 500 characters.

Applicant - Monthly Income The maximum length for the field Applicant - Monthly Income is 500 characters.

Co-applicant - monthly income The maximum length for the field Co-applicant - monthly income is 500 characters.

Home Repairs

Please describe home repairs needed The maximum length for the field Please describe home repairs needed is 5000 characters.